Prevention and Treatment of Opioid Misuse and Addiction
This narrative review addresses the rewarding and analgesic effects of opioids, the epidemiology of the opioid crisis, and interventions used to treat and prevent opioid use disorder. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - December 5, 2018 Category: Psychiatry Source Type: research

A Nationwide Study of Infections and the Subsequent Risk of Mental Disorders in Children and Adolescents
This nationwide register-based cohort study investigates the association between all treated infections since birth and the subsequent risk of development of any treated mental disorder during childhood and adolescence in Denmark. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - December 5, 2018 Category: Psychiatry Source Type: research

Prolonged Exposure Therapy, Sertraline, and Their Combination Among Combat Veterans With PTSD
This randomized clinical trial compares the relative efficacy of prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, and sertraline plus enhanced medication management in the treatment of posttraumatic stress disorder among combat veterans. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - December 5, 2018 Category: Psychiatry Source Type: research

Use of Prolonged Exposure and Sertraline in the Treatment of PTSD for Veterans
For deployed veterans from the wars in Iraq and Afghanistan, the estimated costs of posttraumatic stress disorder (PTSD) and depression were between $4.0 billion and $6.2 billion in the first 2 years after they returned home. A number of efficacious treatments for PTSD exist, including pharmacotherapy and psychotherapies, although the gap between those who could benefit from evidence-based treatment and those who receive it remains large. Across populations, selective serotonin reuptake inhibitors (SSRIs), such as sertraline, have demonstrated moderate effects, while exposure-based therapies, such as prolonged exposure (PE...
Source: JAMA Psychiatry - December 5, 2018 Category: Psychiatry Source Type: research

Infections Associated With an Increased Risk for Neuropsychiatric Illness in Children
Can infections in childhood trigger the development of neuropsychiatric disease? A study by K öhler-Forsberg et al in this issue ofJAMA Psychiatry provides strong epidemiologic evidence that severe infections, as well as exposure to antiinfective agents, place children and teenagers at greater risk for developing neuropsychiatric illnesses. By studying Danish medical records from more than 1 million individuals, the team found that the risk of developing mental disorders in children (age 18 years or younger) was increased by more than 80% after a hospitalization for severe infection. Likewise, the use of medications (...
Source: JAMA Psychiatry - December 5, 2018 Category: Psychiatry Source Type: research

JAMA Psychiatry
Mission Statement:JAMA Psychiatry strives to publish original, state-of-the-art studies and commentaries of general interest to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and allied fields. The journal seeks to inform and to educate its readers as well as to stimulate debate and further exploration into the nature, causes, treatment, and public health importance of mental illness. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - December 1, 2018 Category: Psychiatry Source Type: research

December 2018 Highlights
(Source: JAMA Psychiatry)
Source: JAMA Psychiatry - December 1, 2018 Category: Psychiatry Source Type: research

What Role Should Psychiatrists Have in Responding to the Opioid Epidemic?
This Viewpoint expresses concerns about the workforce available to care for patients with opioid use disorders and advises that psychiatrists become trained in the administration of buprenorphine and acquire other skills. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 28, 2018 Category: Psychiatry Source Type: research

Trends in Serious Psychological Distress and Outpatient Mental Health Care of US Adults
This survey study characterizes US national trends in serious psychological distress and trends in outpatient mental health service use by adults with and without serious psychological distress. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 28, 2018 Category: Psychiatry Source Type: research

Association of Psychotic Experiences With Subsequent Risk of Suicidal Ideation, Suicide Attempts, and Suicide Deaths
This systematic review and meta-analysis examines longitudinal studies on cohorts of individuals with psychotic experiences to determine their likelihood of suicidal ideation, suicide attempts, and suicide death. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 28, 2018 Category: Psychiatry Source Type: research

Risk of Suicide After Cancer Diagnosis in England
This population-based study examines the risk of suicide in patients in England after diagnosis of cancer, including cancer type and stage, time since diagnosis, and sociodemographic factors. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 21, 2018 Category: Psychiatry Source Type: research

Association of Trauma in Childhood and Adolescence With Psychotic Experiences in Early Adulthood
This population-based cohort study investigates whether the type, frequency, and severity of trauma encountered during childhood is associated with an increase in the likelihood of hallucinations, delusions, thought interference, and other psychotic experiences in young adulthood. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 21, 2018 Category: Psychiatry Source Type: research

Comorbid Serious Mental Illness Diagnosis and 30-Day Medical and Surgical Readmissions
This study compares nationwide medical and surgical readmission rates in patients with and without serious mental illness. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 21, 2018 Category: Psychiatry Source Type: research

Advancing Our Understanding of the Who, When, and Why of Suicide Risk
Suicide is one of the most devastating and perplexing of all human behaviors. Whereas the mortality rate for many leading causes of death (eg, tuberculosis, pneumonia, and influenza) has declined over the past century, the suicide rate is virtually identical to what it was 100 years ago. Our lack of progress in suicide prevention is in large part owing to our limited understanding of this problem. Suicidal thoughts and behaviors (STBs) rarely occur in a research laboratory where they can be carefully probed, and we have not had the technology to study them in situ. As a result, we lack a firm understanding of the fundament...
Source: JAMA Psychiatry - November 21, 2018 Category: Psychiatry Source Type: research

Errors in Legend of Figure 3
In the article titled “Effect of Foster Care Intervention on Trajectories of General and Specific Psychopathology Among Children With Histories of Institutional Rearing: A Randomized Clinical Trial,” the legend of Figure 3 has been corrected. “Foster care” was previously blue and is now brown; “Never-institutio nalized” was previously white and is now blue. The middle bar for the “8” category in panel C has also been updated to accurately reflect the corrected figure legend. The article was corrected online. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 21, 2018 Category: Psychiatry Source Type: research

User-Centered Redesign of Evidence-Based Psychosocial Interventions to Enhance Implementation
This Viewpoint provides thoughts on best practices for the implementation of user-center designs in health care. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

Association of Hippocampal Glutamate Levels With Outcomes in People at Risk for Psychosis
This cross-sectional study investigates whether increased hippocampal glutamate levels are associated with adverse clinical outcomes in individuals at clinical high risk for psychosis compared with healthy control individuals, between clinical high-risk individuals who develop and do not develop psychosis, and between individuals with good and poor outcomes. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

Testosterone Treatment and Alleviation of Depression in Men
This systematic review and meta-analysis evaluates randomized placebo-controlled clinical trials to assess the association of testosterone therapy with alleviation of symptoms of depression in men. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

The Meaning of Glutamate and the Quest for Biomarkers in the Transition to Psychosis
The Bossong et al study titled “Association of Hippocampal Glutamate Levels With Adverse Outcomes in Individuals at Clinical High Risk for Psychosis” represents an important step forward in the study of glutamatergic abnormalities in the pathophysiology of psychotic disorders. To our knowledge, this is the largest study of in dividuals at clinical high risk to date to use proton magnetic resonance spectroscopy (1H-MRS) and document that those with higher hippocampal glutamate are more likely to transition to psychosis. The hippocampus was selected as the region of interest because hippocampal abnormalities prio...
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

Testosterone Treatment of Depressive Disorders in Men
The role of testosterone in the pathophysiology and treatment of depressive disorders in men has remained shrouded in controversy. We do not know whether depressive symptoms are a part of the syndrome of testosterone deficiency in men, and if so, whether testosterone replacement relieves such symptoms, whether low testosterone levels contribute to the pathophysiology of depressive disorders in men, and whether testosterone treatment is efficacious in treating men with depressive disorders. A well-performed meta-analysis by Walther et al in this issue ofJAMA Psychiatry attempts to synthesize data from randomized, placebo-co...
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

Error in Figure
In the Special Communication titled “The Development of Kraepelin’s Mature Diagnostic Concepts of Paranoia (Die Verr ücktheit) and Paranoid Dementia Praecox (Dementia Paranoides): A Close Reading of His Textbooks From 1887 to 1899, ” published September 19, 2018, there were 2 errors in the Figure. The arrow connecting the Persecutory form Fourth edition box labeled “Referential subform” to the Grandiose form Fifth edition box labeled “Fantastical form” should instead have connected “Referential subform” to the Pe rsecutory form Fifth edition box labeled “Refe...
Source: JAMA Psychiatry - November 14, 2018 Category: Psychiatry Source Type: research

Screening and Counseling Interventions to Reduce Unhealthy Alcohol Use in Adults 18 Years and Older
This editorial offers thoughts about the 2018 update of the 2013 recommendation statement regarding screening and behavioral counseling for unhealthy alcohol use in adults and adolescents and the updated evidence report and systematic review issued by the US Preventive Services Task Force (USPSTF) and published in this week ’s issue ofJAMA. The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use (B ...
Source: JAMA Psychiatry - November 13, 2018 Category: Psychiatry Source Type: research

Prevention of Major Depression in Older Adults Living in Low- and Middle-Income Countries
This randomized clinical trial assesses whether an intervention for depression prevention provided by lay counselors is effective in older adults from low- and middle-income countries. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

Effect of Damaging Rare Mutations on Antipsychotic Drug Response in Schizophrenia
This randomized clinical trial examines genes and gene sets using exome sequencing technology to determine the genetic mechanism behind the responses to antipsychotic drugs prescribed to patients with schizophrenia. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

Sham Treatment Is as Effective for Treatment-Resistant Depression as Repetitive Transcranial Magnetic Stimulation
To the Editor In a large randomized clinical trial about veterans with treatment-resistant depression, Yesavage et al present data showing that repetitive transcranial magnetic stimulation (rTMS) is not superior to sham rTMS. These data are contrary to other results suggesting that rTMS is an effective intervention for treatment-resistant depression. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

Successes and Challenges in Precision Medicine in Psychiatry
Currently, considerable effort is devoted to finding novel drug targets. Problematically, the development of new medications is extremely expensive and takes many years. A parallel and potentially more immediate route to enhance treatment efficacy and minimize common adverse effects is to tailor the use of existing drugs to individual patients. However, the field of precision medicine has struggled to develop accurate approaches for predicting psychotropic drug response. Initial efforts involved pharmacogenetic studies of candidate genes thought to be relevant to the pharmacokinetics and pharmacodynamics of the drug. These...
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

Preventing Late-Life Depression Through Task Sharing
Late-life depression (LLD) is the most common mental health problem in elderly patients. It has adverse impacts on the outcome of comorbid medical illnesses and is associated with increased risk for dementia and mortality. Subthreshold depression, which is more prevalent than major depression, also contributes to significant burden. High treatment gap for LLD, due to low awareness, stigma, and shortage of trained mental health care professionals, is a significant challenge, particularly in low- and middle-income (LAMI) countries. Late-life depression has low remission rates even after treatment. Together, LLD poses substan...
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

Errors in Statistical Test Results, Figure 2, and eFigure 3
In the Original Article titled “Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction,” published October 1, 2017, there was an error in calculating the overall demand curve measure in the cigarette purchase task and test statis tics corresponding to that measure. The second and third sentences in the Simulation subsection of the Results section should have read as follows: “The estimated rate of smoking decreased as a function of decreasing nicotine dose (F3,75 = 3.04;P = .002). ...
Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research

JAMA Psychiatry
Mission Statement:JAMA Psychiatry strives to publish original, state-of-the-art studies and commentaries of general interest to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and allied fields. The journal seeks to inform and to educate its readers as well as to stimulate debate and further exploration into the nature, causes, treatment, and public health importance of mental illness. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 1, 2018 Category: Psychiatry Source Type: research

November 2018
(Source: JAMA Psychiatry)
Source: JAMA Psychiatry - November 1, 2018 Category: Psychiatry Source Type: research

Comparative Efficacy and Acceptability of Psychotherapies for Pediatric Acute Anxiety Disorders
This network meta-analysis compares and ranks the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 31, 2018 Category: Psychiatry Source Type: research

Association of Autism Spectrum Disorder with Prenatal Exposure to Medication Affecting Neurotransmitter Systems
This population-based case-control study investigates the association of prenatal exposure to medications that interfere with different neurotransmitter systems with the risk of autism spectrum disorders in offspring in a birth cohort of individuals with and without the disorder. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 31, 2018 Category: Psychiatry Source Type: research

The Trump Administration ’s Actions to Address the Opioids Public Health Crisis–Reply
In Reply We appreciate McCance-Katz and Giroir ’s efforts to comment on our article and their enumerating several recent steps the Trump administration has taken to respond to the opioid crisis—a matter of serious concern to the US people. We applaud some of the positive responses by the US Health and Human Services that McCance-Katz and Gir oir identify—in particular enhanced national support for drug use and overdose surveillance efforts, along with treatment efforts targeted toward parents and rural communities. We also are heartened that Congress is responding actively to this crisis, as evidenced by ...
Source: JAMA Psychiatry - October 31, 2018 Category: Psychiatry Source Type: research

The Trump Administration ’s Actions to Address the Opioid Public Health Crisis
To the Editor The opioid crisis is one of the greatest public health challenges of our time. In contrast to the false assertion that “…the federal government appears to be largely conducting business as usual…,” this administration has implemented an aggressive whole-of-government approach; unprecedented funding has been sought, received, and awarded to states and localities to address opioids-related prevention, treatmen t, and recovery services exceeding $3 billion in 2018. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 31, 2018 Category: Psychiatry Source Type: research

A Biology-First Approach in Perinatal Pharmacoepidemiology of Autism
In this issue ofJAMA Psychiatry, Janecka et al conclude that maternal prenatal use of most medications that target specific neurotransmitter systems is not associated with offspring autism. This is a new perspective to consider in view of the hypothesis that there could be adverse neurodevelopmental effects of prenatal medications affecting serotonergic, GABAergic, and glutaminergic neurotransmitters. Although results vary, previous studies have warned of potential bias arising from confounding by maternal indications for prenatal drug treatments, which are stubbornly difficult to resolve. Janecka et al grouped medications...
Source: JAMA Psychiatry - October 31, 2018 Category: Psychiatry Source Type: research

Cardiovascular Treatment and Mortality in Post –Myocardial Infarction Patients With Schizophrenia
This study uses the Danish nationwide health care registries to investigate the association of secondary preventive cardiovascular treatment with all-cause mortality after myocardial infarction in patients with schizophrenia compared with those without schizophrenia. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 24, 2018 Category: Psychiatry Source Type: research

Danish-like Regulations May Improve Postabortion Mental Health Risk —Reply
In Reply We are happy to respond to Sullins and Harrison regarding our findings that having an abortion is not associated with increased likelihood of antidepressant use among women in Denmark. They raised 2 issues. One involved using receipt of an antidepressant prescription as an indicator of depression. They noted the articles we cited as indicating that “half of antidepressant prescriptions were for nondepressive indications.” This would be problematic if our intent was to isolate the effects of abortion on first depressive episode only. However, we were interested in common mild to moderate mental health e...
Source: JAMA Psychiatry - October 24, 2018 Category: Psychiatry Source Type: research

Danish-like Regulations May Improve Postabortion Mental Health Risk
To the Editor Steinberg and colleagues ’ study of Danish prescription records suggests that from parity in first antidepressant use after abortion and childbirth in Denmark, state policies restricting abortions in the United States may not be justified. There are good reasons to question the results; in the cited sources, half of antid epressant prescriptions were for nondepressive indications. However, if indicative of benign depression outcomes after Danish abortions, the results more likely support the opposite conclusion regarding abortion restrictions. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 24, 2018 Category: Psychiatry Source Type: research

Can Better Cardiovascular Care Close the Mortality Gap for People With Schizophrenia?
This editorial comments on recent data that show a mortality gap between individuals with and without schizophrenia, with changes in the disparity as the amount of medical care given increases. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 24, 2018 Category: Psychiatry Source Type: research

Error in Table 2
In the Original Investigation by Grisanzio et al titled “Transdiagnostic Symptom Clusters and Associations With Brain, Behavior, and Daily Function in Mood, Anxiety, and Trauma Disorders,” published online December 3, 2017, inJAMA Psychiatry, 2 numbers in Table 1 were incorrect. In the row labeled “Anhedonia” and the column labeled “Tension,” the number −0.047 should have been −0.471; in the row labeled “Anxious arousal” and the column labeled “Normative Mood,” the number −0.026 should have been −0.257. Both numbers have been corrected. (So...
Source: JAMA Psychiatry - October 24, 2018 Category: Psychiatry Source Type: research

A Case of a College Student Presenting With Mild Mental Health Problems
A college student presents to a psychosis early-detection clinic with declined functioning and social withdrawal. What would you do next? (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Predisposition vs Individual Processes in Psychotic-like Experiences in Cannabis Users
This cross-sectional study uses data from the Human Connectome Project and the Australian Twin Registry collected from twin and nontwin sibling pairs to investigate genetic and environmental factors in psychotic-like experiences associated with cannabis use. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Effect of Prefrontal Cortex on Regulation of Amygdala Response to Threat in Trait Anxiety
This randomized clinical trial investigates the effect of stimulation of the prefrontal cortex vs sham procedure on amygdala threat reactivity in individuals with anxiety. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Precision Psychiatry —Yes, But Precisely What? —Reply
In Reply G ómez-Carrillo et al suggest that precision psychiatry will be impossible unless it “…integrates multilevel explanatory models with cross-level dynamics and situates individuals’ illness experience within a social context.” The authors claim that our Viewpoint relies on a “…view [that] p erpetuates current reductive explanatory approaches.” We of course agree with the importance of social and environmental context and of treating individuals as whole persons. However, our Viewpoint was oriented toward providing specific examples of how genomic insights can advanc...
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Precision Psychiatry —Yes, But Precisely What?
To the Editor In a recent Viewpoint, Stein and Smoller stress the need for a paradigm shift in psychiatry, acknowledging the crisis in the field. We could not agree more. Drawing from the example of cardiovascular disease, they propose that “…genomic medicine [will be] the tip of the spear for the coming advances in precision psychiatry” and lead to the much-awaited paradigm shift. Here, we could not disagree more. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

The Science of Prognosis in Psychiatry
This narrative review presents an approach to incorporating clinical risk prediction models in psychiatry, highlights challenges, and provides recommendations to improve understanding of prognosis in psychiatry. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Developmental Trajectories and Neuropsychiatric Genetic Risk Variants in Early-Onset Depression
This population-based study examines the association between genetic risk variants for neuropsychiatric disorders and the age at onset and trajectories of depression in children. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 14, 2018 Category: Psychiatry Source Type: research

Mapping the Heterogeneous Phenotype of Schizophrenia and Bipolar Disorder Using Normative Models
This study uses normative modeling to map regional brain alterations to examine brain structural heterogeneity in adults with schizophrenia and bipolar disorder vs healthy individuals. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 10, 2018 Category: Psychiatry Source Type: research

Using Brain-Based Phenotyping to Improve Discovery in Psychiatry
Many lines of evidence from different laboratories are now joining the same chorus: that conventional psychiatric diagnoses of serious mental illness (SMI), when tested, do not show a common biology. The article by Wolfers et al notes that SMI diagnoses do not have strong biomarkers similar to those that are already increasingly valued in the rest of medicine and that could help define disease groups, select treatments, and mark clinical outcomes. The authors used innovative regional brain structure mapping on an individual basis in people with schizophrenia and bipolar disorder and developed voxel-by-voxel measures of ind...
Source: JAMA Psychiatry - October 10, 2018 Category: Psychiatry Source Type: research

Autoimmune Thyroiditis and Depression —Reply
In Reply We have read the Letters concerning our article on autoimmune thyroiditis (AIT) with interest and thank the different authors for their time and effort. There were many positive reactions to the contents of the article. (Source: JAMA Psychiatry)
Source: JAMA Psychiatry - October 10, 2018 Category: Psychiatry Source Type: research